Treatment Assignment, Dropout, and Outcome of Depressed Patients Who Somaticize

Depressed patients with high scores on measures of somatization were studied in two forms of treatment—pharmacotherapy with nortriptyline hydrochloride (N = 36) and cognitive behavioral group therapy (N = 66). Three hypotheses were tested: (1) that depressed patients with somatic distress are more often assigned to pharmacotherapy than are other depressed patients; (2) that patients who somaticize find pharmacotherapy aversive and are (a) more likely than other patients to drop out of treatment, and (b) less likely to show improvement; and (3) that this relationship does not hold for patients receiving cognitive-behavioral group therapy. The results showed that depressed patients with somatic complaints were assigned more often to pharmacotherapy than to cognitive-behavioral group therapy (p < .05), and they subsequently dropped out of that treatment more often than other patients (p < .01). In addition, somaticizers who completed the treatment showed less improvement than other patients (p < .05). This relationship did not hold for patients receiving cognitive-behavioral group therapy. Possible strategies are discussed for treating depressed patients with somatic complaints.